1932469343 NPI number — REGENT PHYSICIANS OF ARIZONA, PLLC

Table of content: (NPI 1932469343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932469343 NPI number — REGENT PHYSICIANS OF ARIZONA, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENT PHYSICIANS OF ARIZONA, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932469343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1951 N WILMOT RD
Provider Second Line Business Mailing Address:
BLDG 1, STE 2
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85712-8000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-722-3777
Provider Business Mailing Address Fax Number:
520-296-6224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1590 PASEO SAN LUIS
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
SIERRA VISTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85635-4782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-220-5711
Provider Business Practice Location Address Fax Number:
520-220-5709
Provider Enumeration Date:
05/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SERFINO
Authorized Official First Name:
LEONARDO
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
520-220-5711

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  30887 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 736598 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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